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Increase in Central Retinal Edema after Subthreshold Diode Micropulse Laser Treatment of Chronic Central Serous Chorioretinopathy.

Gawęcki M - Case Rep Ophthalmol Med (2015)

Bottom Line: Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%.Conclusion.In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration.

View Article: PubMed Central - PubMed

Affiliation: Dobry Wzrok Ophthalmological Clinic, Kliniczna 1B/2, 80-402 Gdańsk, Poland.

ABSTRACT

Unlabelled: Purpose. Subthreshold diode micropulse laser (SDM) treatment is believed to be safe method of treating clinical entities involving retinal edema. We present a case of serous edematous reaction of the retina to SDM treatment. Methods.

Case report: Results. A patient with chronic central serous chorioretinopathy (CSCR) was treated with SDM Yellow multispot laser. Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%. The follow-up visit two days after treatment revealed significant central retinal edema and subretinal fluid. Fundus autofluorescence image showed thermal reaction from the RPE in the form of small spots of hyperfluorescence corresponding to the laser multispot pattern used for treatment. Retinal edema resolved after topical bromfenac and single intravitreal bevacizumab injection. Slight pigmentary reaction from the RPE persisted. Conclusion. In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration.

No MeSH data available.


Related in: MedlinePlus

OCT scan a month after SDM treatment. Resorption of the subretinal fluid and slight reduction of the retinal thickening in comparison to the scan taken before laser treatment.
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fig4: OCT scan a month after SDM treatment. Resorption of the subretinal fluid and slight reduction of the retinal thickening in comparison to the scan taken before laser treatment.

Mentions: 33-year-old female patient was admitted to our outpatient clinic due to chronic serous chorioretinopathy in the RE. LE also suffered from chronic CSCR and in the course of the disease developed epiretinal membrane (ERM) and serious decrease in best corrected visual acuity (BCVA). 5 years ago LE underwent pars plana vitrectomy with ERM peeling and vision stabilized at the level of 0,2. In a few recent years RE had a few episodes of subretinal fluid in the macula. At the time of presentation BCVA in RE was 0,63. On the OCT scan there was retinal thickening present in the foveal region, as well as subretinal fluid outside the foveal area (Figure 1). Patient complained from gradual subjective deterioration of vision in RE and was willing to undergo treatment. As a first line of treatment, intravitreal injection of 1,25 mg of bevacizumab was offered and administered, but it did not bring any effect in terms of reducing retinal thickness or improvement of vision. The patient did not want to continue the treatment because of the cost of injection, so SDM treatment in the macular area was planned. We planned to treat the areas of the retina with subretinal fluid present, as well as the areas of retinal thickening without subretinal fluid. Patient received two sessions of SDM separated by 3-month interval. Treatment was performed with 577 Yellow multispot laser. Before each treatment we employed titration scheme on the edge of edematous and normal retina and reduced laser power by half. We used confluent pattern at the peripheral retina with subretinal fluid and on thickened retina around the foveola, sparing the central part. During one session we made around 600 impacts in the macular region each of 160 μm in diameter, using 550 mW power, 0,2 seconds duration, and 5% duty cycle. After the first session there was no change in central retinal thickness (CRT) and visual acuity. After the second, patient noted significant drop in visual acuity and came back for the follow-up visit in two days. Ophthalmological examination revealed BCVA drop from 0,63 to 0,32. On SD OCT there was significant amount of subretinal fluid present in the macular area (Figure 2). There were no cystoid changes in the sensory retina. Autofluorescence image showed punctate areas of hyperfluorescence referring to multispot laser pattern used for the treatment (Figure 3). Patient was put on topical bromfenac twice a day and was scheduled for anti-VEGF (bevacizumab) treatment in 7 days. One week after the injection significant reduction of amount of subretinal fluid was noted on SD OCT and improvement in BCVA to 0,5. A month after the injection we achieved complete resolution of subretinal fluid. BCVA was back to 0,63—same as before laser treatment—and CRT was slightly reduced as compared to the state before laser therapy (Figure 4). Fundus examination revealed small pigmentary changes corresponding to laser pattern used for treatment.


Increase in Central Retinal Edema after Subthreshold Diode Micropulse Laser Treatment of Chronic Central Serous Chorioretinopathy.

Gawęcki M - Case Rep Ophthalmol Med (2015)

OCT scan a month after SDM treatment. Resorption of the subretinal fluid and slight reduction of the retinal thickening in comparison to the scan taken before laser treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4477113&req=5

fig4: OCT scan a month after SDM treatment. Resorption of the subretinal fluid and slight reduction of the retinal thickening in comparison to the scan taken before laser treatment.
Mentions: 33-year-old female patient was admitted to our outpatient clinic due to chronic serous chorioretinopathy in the RE. LE also suffered from chronic CSCR and in the course of the disease developed epiretinal membrane (ERM) and serious decrease in best corrected visual acuity (BCVA). 5 years ago LE underwent pars plana vitrectomy with ERM peeling and vision stabilized at the level of 0,2. In a few recent years RE had a few episodes of subretinal fluid in the macula. At the time of presentation BCVA in RE was 0,63. On the OCT scan there was retinal thickening present in the foveal region, as well as subretinal fluid outside the foveal area (Figure 1). Patient complained from gradual subjective deterioration of vision in RE and was willing to undergo treatment. As a first line of treatment, intravitreal injection of 1,25 mg of bevacizumab was offered and administered, but it did not bring any effect in terms of reducing retinal thickness or improvement of vision. The patient did not want to continue the treatment because of the cost of injection, so SDM treatment in the macular area was planned. We planned to treat the areas of the retina with subretinal fluid present, as well as the areas of retinal thickening without subretinal fluid. Patient received two sessions of SDM separated by 3-month interval. Treatment was performed with 577 Yellow multispot laser. Before each treatment we employed titration scheme on the edge of edematous and normal retina and reduced laser power by half. We used confluent pattern at the peripheral retina with subretinal fluid and on thickened retina around the foveola, sparing the central part. During one session we made around 600 impacts in the macular region each of 160 μm in diameter, using 550 mW power, 0,2 seconds duration, and 5% duty cycle. After the first session there was no change in central retinal thickness (CRT) and visual acuity. After the second, patient noted significant drop in visual acuity and came back for the follow-up visit in two days. Ophthalmological examination revealed BCVA drop from 0,63 to 0,32. On SD OCT there was significant amount of subretinal fluid present in the macular area (Figure 2). There were no cystoid changes in the sensory retina. Autofluorescence image showed punctate areas of hyperfluorescence referring to multispot laser pattern used for the treatment (Figure 3). Patient was put on topical bromfenac twice a day and was scheduled for anti-VEGF (bevacizumab) treatment in 7 days. One week after the injection significant reduction of amount of subretinal fluid was noted on SD OCT and improvement in BCVA to 0,5. A month after the injection we achieved complete resolution of subretinal fluid. BCVA was back to 0,63—same as before laser treatment—and CRT was slightly reduced as compared to the state before laser therapy (Figure 4). Fundus examination revealed small pigmentary changes corresponding to laser pattern used for treatment.

Bottom Line: Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%.Conclusion.In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration.

View Article: PubMed Central - PubMed

Affiliation: Dobry Wzrok Ophthalmological Clinic, Kliniczna 1B/2, 80-402 Gdańsk, Poland.

ABSTRACT

Unlabelled: Purpose. Subthreshold diode micropulse laser (SDM) treatment is believed to be safe method of treating clinical entities involving retinal edema. We present a case of serous edematous reaction of the retina to SDM treatment. Methods.

Case report: Results. A patient with chronic central serous chorioretinopathy (CSCR) was treated with SDM Yellow multispot laser. Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%. The follow-up visit two days after treatment revealed significant central retinal edema and subretinal fluid. Fundus autofluorescence image showed thermal reaction from the RPE in the form of small spots of hyperfluorescence corresponding to the laser multispot pattern used for treatment. Retinal edema resolved after topical bromfenac and single intravitreal bevacizumab injection. Slight pigmentary reaction from the RPE persisted. Conclusion. In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration.

No MeSH data available.


Related in: MedlinePlus